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[INTRO ♪]
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There are a lot of ways to mark the passing
of a loved one.
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But in many modern cultures, once the funeral’s
over,
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all that’s left are too many flowers and
that well-meant
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soggy casserole your neighbor made for you.
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Those black mourning dresses Scarlett O’Hara
hated so much
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have gone out of style, but grief doesn’t
stop
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just because the public ceremony of saying
goodbye is over.
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Grief can be hard and lonely, and sometimes
it can feel like it’ll never end.
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Psychologists have been trying to figure this
out for over a century.
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And the only good answers they’ve got are
that
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it’s a totally normal process, and that
it’s different for everyone.
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Bereavement is the technical term that psychologists use
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to talk about the loss of a loved one by death.
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Grief is what they call the distress caused
by that loss.
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And when you think about grief in a psychological
sense,
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the first thing that probably comes to mind
is the Kübler-Ross model.
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You might not recognize that name,
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but it gets talked about a lot in pop culture.
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You might, for instance, know it from
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that Robot Chicken video of a giraffe stuck
in quicksand.
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Basically, the Kübler-Ross model says
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we all go through five stages as we process
our grief.
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We start off by denying that whatever happened
is real,
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which helps us temporarily deal with it.
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Next, we get angry.
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And then, we try to bargain our way out of it,
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by making a deal with God, or the universe,
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or whatever we believe has the power to change
what has happened.
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When that doesn’t work, we experience depression.
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And finally, we get to acceptance.
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Everything might not be okay, but we’ve
learn to live with it.
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Even if you haven’t taken a psychology class,
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you’re probably familiar with this idea.
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But you might not know where the model comes
from.
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Elisabeth Kübler-Ross was a psychiatrist
who worked with terminally ill patients.
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She helped change attitudes about dying
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and encouraged people to actually talk about
death.
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And rather than just worrying about the salvation
of the soul,
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she was a strong supporter of hospice care,
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which focuses on making the patients’ final
days comfortable
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and keeping them involved in the decisions
that affect them.
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This is all super important stuff that has
affected
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how we think about people who are dying.
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But she also wrote a book called On Death
and Dying.
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Published in 1969, it was based on interviews
with over 200 dying patients.
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Kübler-Ross was influenced by the work of
two psychiatrists
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who proposed that, after a separation or a
loss,
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grief was a process that involved four sequential
stages.
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So in her book, she proposed five stages we
all go through
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as we come to terms with dying.
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Not while grieving for someone else, but while
dying ourselves.
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The book sold really well, and the five stages
took off in the public’s imagination.
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People started applying the stages to grief
even though they weren’t meant to describe it.
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And so, Kübler-Ross and her coauthor eventually
went back
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and adapted the same five stages so that they
made sense for grieving, too.
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But! There wasn’t really any scientific basis
for that adaptation.
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Of course, we didn’t always think of grieving
as a pattern of psychological responses.
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Since death is inevitable, people have been
studying grief for a while.
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In the 17th century, it was believed that
too much grieving could be deadly.
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And in the 19th century, Charles Darwin wrote
about grief
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and noted that monkeys and apes also seemed
capable of feeling it.
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Freud had something to say about it too.
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In 1917, he proposed that the living had to
detach their emotional energy
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from the dead person and channel it into some
other aspect of their lives.
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He called this grief work.
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And if people didn’t do grief work?
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He believed they had a much higher risk of
developing a psychological illness
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because of their supposedly pathological grief.
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Yeah, Freud had… a lot of ideas, and they
weren’t always great.
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But, of all these ideas, the Kübler-Ross
model is the one that really stuck around.
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Some psychologists think that its staying
power
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comes from the fact that it’s such a good
narrative.
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Our brains like to organize things, and this
model offers
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a nice, neat progression through five well-defined
stages—
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and ultimately, has a happy ending.
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But even though we might like the way it sounds,
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psychologists nowadays have a few big issues
with these five stages.
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First of all, there’s a lack of empirical
evidence.
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Many researchers argue that the interviews
it’s based on
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weren’t conducted with enough scientific
rigor.
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In the years since the book was published,
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some studies have attempted to replicate and
verify the findings.
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For instance, one study published in 2007
followed 233 people over three years.
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And a 2010 study looked at 614 undergraduates
and surveyed them once,
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all at different points in their grief.
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Both studies asked the subjects to assess
their grief on a scale
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for disbelief, yearning, anger, depression,
and acceptance.
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And they all had mixed results.
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The 2007 study found that acceptance was the
most common reaction,
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even right after death.
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But after averaging all the data over time
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the different stages did peak in the order
that Kübler-Ross had suggested.
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The 2010 study found that their results didn’t
support Kübler-Ross’s stage theory,
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but they didn’t completely disprove it either.
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And how much people were thinking about the
loss
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seemed to influence what they were experiencing
more than the passing of time.
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A second criticism is that the stages don’t
really have an underlying explanation.
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There’s no hypothesis for why grief would
be organized
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into sequential stages, what function they
serve,
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or how people move from one stage to the next.
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On top of that, the stages are kind of random,
psychologically speaking.
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Some of them are emotional states, like anger
and depression,
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while others are cognitive processes, like
acceptance and denial.
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And lastly, researchers have noted that the
Kübler-Ross model
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seems to create problematic expectations for
how grief should be dealt with.
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The five stages can make people expect
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to experience certain things in a certain
order.
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And if they don’t do that, or they don’t hit
certain stages at all,
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people might believe that they aren’t coping
properly.
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That expectation could also lead to unhelpful
support
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from their social networks or health care
professionals.
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But psychologists aren’t just critiquing
the Kübler-Ross model,
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they’re also trying to figure out new ways
to think about grief.
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There’s a ton of research to sift through,
but there are a few prominent ideas.
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The dual-process model of grief was proposed
in 1999.
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Developed from other studies on cognitive
stress,
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it suggests that the griever switches back
and forth
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between two patterns of behavior, called orientations.
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In the loss orientation, someone spends time
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thinking about the person they’ve lost and
what life used to be like.
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They might look at old pictures or tell stories,
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and they’ll express a lot of emotion about
the loss.
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In the restoration orientation, someone focuses on
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the changes that need to be made.
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It’s more of a problem-solving state of
mind.
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They might work on establishing a new identity
for themselves
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or adjusting to do things that the deceased
used to do,
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like doing the dishes after you cooked.
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What’s unique about the dual-process model
is that it suggests that
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a person who’s grieving switches back and
forth between these two orientations
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until eventually, they don’t need to think
about certain aspects of the loss anymore.
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It’s a more flexible model, with room for
individual and cultural differences.
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One of the best known task-based models of
grief was proposed in 2008 by a
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clinical psychologist with a lot of experience
treating people dealing with grief.
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While this one also doesn’t have a ton of
empirical evidence,
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unlike stage-based models, it tries to account
more for
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people going through grief differently.
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The model says that grieving is a process
of engaging in four tasks—
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all in no particular order.
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Essentially, they include: accepting the reality
of the loss,
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processing the pain of the grief, adjusting
to the world without the loved one,
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and finding a lasting connection with them
somehow.
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The task-based model also points out seven
factors
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that can affect the individual experience
of each griever,
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which may help healthcare professionals understand
what someone’s going through.
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These factors are things like their relationship
to the deceased,
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how the person died, or other stress that
they’re under.
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Another prominent way of thinking about grief
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identifies multiple possible grieving processes,
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reinforcing that it can be very different
for different people.
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This idea started with a 2002 study on 205
people who lost their spouses.
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The researchers tracked subjects for several
years before the death until 18 months afterward.
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And they used this information to identify
five common trajectories of grief.
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The trajectories include common grief,
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in which the subjects experience a lot of
depression at six months,
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but not before the death or at 18 months.
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There’s also depressed-improved,
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in which the subject experienced depression
before the death,
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but had largely returned to normal by six
months.
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In chronic grief and chronic depression trajectories,
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the subject experienced many grief symptoms
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and high levels of depression at six months
and 18 months.
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These were both associated with higher dependence
on the spouse before death.
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But they were distinguishable.
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In the case of chronic depression,
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the subject experienced depression before
the death as well,
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and it was associated with marital strife.
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The most common trajectory was actually resilience,
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in which a person experiences relatively low
and stable levels of depression
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before and following the loss.
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Nearly half the subjects experienced this
pattern.
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Now, all these ideas suggest that grief can
be different
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depending on the circumstances and the person—
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which makes a lot of sense!
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Grief is really complicated.
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But there’s just so much research out there.
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And some psychologists worry that without
a tidy, unified narrative,
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it will be hard to dislodge the Kübler-Ross
model in the general public’s mind.
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The other thing to know is that there can
be complications
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that make grief extra hard to deal with.
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For example, there’s disenfranchised grief,
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which is what psychologists call grief that
isn’t generally acknowledged by society.
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Like, when someone you didn’t actually know
dies
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or when you experience a miscarriage.
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It’s not as socially acceptable to feel
and talk about those kinds of grief,
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which can make them harder to process.
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But even typical grief can become a problem.
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The DSM-5, an evolving guide that professionals
use to diagnose mental illness,
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includes proposed criteria for Persistent
Complex Bereavement Disorder.
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These criteria are things like: longing for
the deceased, intense suffering,
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and preoccupation with the death that causes
distress and impairment lasting over a year.
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So if grief is such a complicated, intense
experience... can therapy help?
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Unfortunately, a 2008 meta-analysis published
in Psychological Bulletin
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found that, most of the time, grief therapy
didn’t seem to
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significantly help the average person.
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It did somewhat help the people who were having
the most trouble coping, though.
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Like if they're experiencing some of the complications
we just talked about.
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But to be clear: we here at SciShow aren’t
health professionals,
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and everyone processes grief differently.
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So even though some research says therapy
might help
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certain people more than others, it’s not
worth writing off completely.
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The good news, though, is that most people
can move past their grief.
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Or at least, they can move past the most difficult
stage of it, known as acute grief.
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That’s the really sucky part with all of
the physiological symptoms…
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where you’re exhausted, your stomach feels
empty, or you have a lump in your throat.
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Most people seem to be able to move beyond
this in three to six months.
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They still miss their loved one, but they
can get on with living their lives.
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And plenty of researchers see establishing
a lasting relationship
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with the deceased as part of coping.
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The thing is… grief really is a normal process.
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It can be really tough on the mind, but you’ll
get through it okay.
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Thanks for watching this episode of SciShow!
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If you want to learn more about brains and
why humans act the way that we do,
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you can come check out our other channel SciShow
Psychology, at youtube.com/scishowpsych.
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[OUTRO ♪]
